After July 1, an abortion should be as simple to have as a tonsillectomy, but —

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IT all looked so simple on April 10, the day the New York State Legislature finally amended the state's penal law to give New York the most liberal abortion statute in the United States.

The Legislature's language was sparse and seemed scarcely open to misinterpretation. “An abortional act is justifiable when committed upon a female with her consent by a duly licensed phy sician acting, (a) under a reasonable belief that such act is necessary to preserve her life, or (b) within 24 weeks from the commencement of her pregnancy. . . . The act shall take effect July 1970.”

July 1 is almost here, and what looked so simple 11 weeks ago has turned out to be a source of bureaucratic wrangling, dispute and even bitter ness within the medical community, and wide spread confusion on the part of the general public.

There is no one in the state who can say pre cisely what July 1 will bring; it is quite possible that no one will really know what July 1 brought until the dust settles in a month or so and the statisticians and planners can go to work. Many hospitals have been reluctant to make detailed plans without knowing exactly how many women will want abortions. Without plans, it is impossible to estimate how many abortions can be handled. Juggling these two unknowns, many of those re sponsible for implementing the new law feel as they have been chasing their tails these last two and a half months, fearing all the while that, with abortions, the alternative to planning may be chaos.

The language of the new law, apparently so straightforward, meant different things to differ ent people. To those who had been in the fore front of the reform fight, the new law seemed promise, at least, quick, low‐cost abortions on re quest for women everywhere. After all, the law contained no residency requirement and nothing to prohibit doctors from performing abortions in their offices or in clinics—thus bypassing the high cost of hospital care. At last, it seemed, abortion had been placed where it belonged—in the legal category of, perhaps, a tonsillectomy, with no more red tape, committees, humiliation or exploi tation.

But to those who suddenly found themselves faced with administering the new law, the vision it evoked was quite the opposite. They saw num bers.

New York was about to become the only state in the country to liberalize its abortion law with out adding a residency requirement. Last year, there were an estimated 1.2 million abortions performed in the United States. All but 30,000 or 40,000 of them were illegal. In addition, an esti mated 800,000 women carried their pregnancies to term only because they could not get legal abortions and could not bring themselves to go to an illegal abortionist. Thus there is a potential national demand for abortions of about two mil lion a year.

With New York the only place for most of these women to go, what would happen if they all came here? Indeed, what would happen to the esti mated 50,000 to 100,000 New York City women alone who would seek abortions?

The doctors and planners—including those who had fought for abortion reform—who reacted these statistics with horror also knew another sta tistic. Hospitals in New York City have 3,160 obstetrical beds and last year performed all of 850 therapeutic abortions.

How could the system get ready to transform itself so drastically? If it failed, would the city see a proliferation of abortion mills, technically legal but medically unsound? Would profiteering, unscrupulous practitioners prey on desperation as they always had? What was to become of the practice of medicine in New York? The old, rigid law had certainly hurt many people. Would the new law injure countless more by holding out a promise of what could not be safely delivered?

Clearly, if getting the new law passed had been a difficult task, arranging for its implementation was going to be monumental.

No one doubted that the new law would make abortions more available than ever before. The question was not whether to move, but how quickly and in what direction. Most people who had ever thought about it acknowledged that abortion repeal was destined to come, some day. Suddenly, that day was less than three months away.

THE controversy focused on two issues: a resi dency requirement and where abortions were to be performed. Both became questions of more than merely handling the numbers; they involved the social and medical issues at the heart of the imple mentation problem.

If abortion were to be made available to the poor, the women who had suffered most at the hands of illegal abortionists, then obviously the operation would have to be available in places where costs could be kept low—doctors offices and clinics.

To restrict the operation to hospitals would be to keep abortion largely as a privilege of the rich; to restrict it to New Yorkers would be to make it the privilege of the New York rich.

On the other hand, did abortion in offices and clinics constitute good medicine? And, if there were to be compromises, where should they be made, at the expense of large numbers or at the expense of absolute medical standards?

That question raised another. There has been, and continues to be, vigorous disagreement about what those medical standards are, and with good reason. The medical profession as a whole has surprisingly little experience with abortion. Because for 140 years abortion in New York has been part of the penal law, it never entered the sphere of medical discretion. The medical profession never had a chance to reach a consensus on “standard medical practice” regarding abortion; until quite recently, and then only in a relatively few big‐city hospitals, an abortion which was not clearly indicated to save the mother's life was simply not performed. The operation was not done in large enough num bers for doctors to develop a widely shared body of knowledge. The average New York City gyne cologist, with operating privileges at an average voluntary hospital, probably has been performing about one abortion a year, if that many. In upstate areas, the figure is probably even lower.

Doctors who did perform medically sound, although il legal, abortions in their offices did not publish papers or share their experience with their law ‐ abiding colleagues. There are no precise figures, of course, but those doctors represented only a small per centage of the whole. Even the most outspokenly liberal gynecologists, when abortion committees at their hospitals refused to approve the opera tion for their patients, had to content themselves with re ferring the patients to Eng land or Japan or, in even more rare cases, to one of the better‐known out‐of‐state abortionists.

To understand the medical aspects of the controversy, it is worthwhile to examine the nature of the abortion opera tion. There are currently four medically accepted abortion procedures in use in this country.

The most common is dila tion and curettage. The open ing of the cervix, or lower portion of the uterus, is dilat ed with a series of instruments in graduated sizes to allow the insertion of a curette, or scraping instrument, into the uterus. The pregnancy is then scraped from the uterine wall.

A “D‐and‐C,” as the proce dure is usually called, is ad vised only during the first 10 or 12 weeks of pregnancy. It can be done under a local anesthetic, which is injected alongside the cervix. However, in women who have never given birth, the opening to the cervix is only about the diam eter of a broom straw. The dilation procedure then can be quite difficult and time‐con suming, and general anesthe sia is usually preferred.

Another method for abortion in early pregnancy is uterine aspiration, usually called suc tion. The cervix is dilated as in a D‐and‐C, and then the uterus is evacuated by means of a vacuum suction machine. This method, which was intro duced from Japan to Europe and then into the United States about 12 years ago, is neater, quicker and generally considered safer than a D‐and‐C, since there is less chance of perforating the uter us. Like a D‐and‐C, suction can be performed under local anesthesia on a woman who has previously had children. Both can be performed on an out‐patient basis, allowing sev eral hours for recovery and to watch for possible complica tions.

For pregnancies up to 20 weeks — the latest most doc tors will recommend abortion —one method is a hystero tomy, actually a Caesarian operation in which the uterus is opened from above and the fetus removed. A hysterotomy is major surgery and requires at least several days in the hospital.

A newer method called “salting out” has recently been gaining favor in some of the larger hospitals. In this proce dure, a hypodermic needle is inserted through the abdomen and uterine wall into the am niotic sac, which contains the amniotic fluid and the fetus. About 200 cc. of amniotic fluid are removed, and are re placed by no more than that amount of a 20 per cent saline solution. The saline solution kills the fetus and induces labor. Labor begins from 12 to 36 hours after the injection, and the woman expels the fetus in a normal delivery. Salting out can be done under local anesthesia; in some cases, women have been able to go home and return to the hos after labor has begun.

NONE of these procedures is especially formidable, as operations go. On the other hand, they are operations, and none are without possible dan ger and discomfort. “The pub lic has gotten the idea that an abortion can be done in a few minutes,” says Dr. Sherwin A. Kaufman, a practicing gyne cologist who is also medical director for Planned Parent hood of New York City. “Un der some ideal conditions, it can be. But changing the law doesn't change the nature of the procedure. It is still a medical procedure that de serves to be treated with the greatest respect.”

An ideal abortion, Dr. Kauf man said, is one that would be performed on a woman less than 10 weeks pregnant who had already had one or more babies. As either factor changes, the chance of compli cations is likely to increase. Doctors fear that many wo men who ordinarily would have sought illegal abortions or would have prepared to have their babies have been waiting until July 1 to ask for their abortions, although by then they will be more than 12 weeks pregnant. To the problem of large numbers will be added a disproportionately high number of complicated abortions.

Ironically, the leading med ical spokesman for the con servative approach to both a residency requirement—impos ing one—and out ‐ of ‐ hospital abortions—forbidding them— is Dr. Robert E. Hall, president of the Association for the Study of Abortion and an as sociate professor of obstetrics and gynecology at Columbia University.

His role is ironic because he has been in the forefront of the abortion‐repeal movement for years. Only last winter, he was a plaintiff in a Federal Court suit which sought to have New York's abortion law declared unconstitutional. (The suit was dropped when, a week before the case was to be heard, the new law was passed.) In the months since then, in the eyes of some of his associates, Dr. Hall has turned from a hero into some thing of a goat. The trans formation amuses him. “I've never seen articulate, intelli gent people flip like they did when I started talking about this,” he says.

Dr. Hall bases his views on the limited abortion experi ence of most doctors here and on his conviction that New York's handling of its abortion law will be a crucial test for the course of abortion reform in the rest of the country.

He has studied abortion sta tistics for several years and is the editor of a two‐volume study, “Abortion in a Chang ing World.” “We don't know the precise demand, but we can certainly guess the ball park,” he says. New York women, he estimates, will seek about 50,000 abortions a year. Without a residency re quirement, about 500,000 wo men would come to New York, almost all of them to New York City.

IN 1968, only 68 of the city's 136 hospitals performed any abortions at all. To meet a demand of 50,000, each of those hospitals would have to do about 14 abortions a week, a number Dr. Hall calls “feas ible.” With half a million abortions, each hospital would have to do about 20 a day— feasible in time, but “there is almost no hospital presently able to do that,” he says.

“To cope with even 50,000 abortions, 80 to 90 per cent of them will have to be done on an out‐patient basis, using suc tion and minimal anesthesia. There isn't one doctor in the state of New York who has ever done a legal abortion un der those three conditions out‐patient, local anesthesia and suction. To do 50,000 with these strange new techniques will be trouble enough in a hospital. But let the floodgates open, let in 500,000, and you will have to have independent clinics to accommodate them. Then you will have deaths, profiteering, gruesome stories on the front pages of the papers.

“Next January, the Legisla ture will meet again and say, ‘See what a mess they've made of the abortion law,’ and they'll rescind it. The other 49 states, looking at the New York experience, will see us screwing it up and will stay away from abortion repeal. I'm even naive enough to be lieve that Supreme Court Jus tices read the papers, and that they will wonder why they should legalize abortion repeal for the whole country if this is the way we behave in New York.

“To say that a residency requirement and hospital re strictions will keep abortion underground, will keep abor tions away from poor women, is one thing—but to what end? For the larger goal—to en hance the chance of nation wide repeal forever.

“I've fought for repeal for seven years, and I don't want to see it jeopardized by our experience here. All we need is breathing time, a grace pe riod to start doing abortions under the best possible condi tions. Then, possibly in a year, when we see where we are going, when other states start

relaxing their laws and easing the demand on New York, then we can safely open up.”

Dr. Hall's pessimistic prem ise is not universally shared. The National Association for Repeal of Abortion Laws and other groups have been refer ring thousands of women to technically illegal but medi cally competent abortionists. Most of the operations have been D‐and‐C's performed in the doctor's office without complications. These groups point out that it is the butchers — unqualified people who take no sanitary precau tions — who have given in office abortions a bad name.

“New York women, Dr. Hall estimates will seek about 50.000 abortions a year. Without a residency requirement, about 500,000 women would come to New York almost all of them to New York City.”

“A qualified person can safely perform an abortion anywhere,” said Dr. Bernard Nathanson, chief of gynecol ogy at the Hospital for Joint Diseases (a general hospital, despite its name). On July 1, Dr. Nathanson will preside at a day‐long training session on the techniques of out‐of hospital abortions, sponsored by the National Association for Repeal of Abortion Laws. More than 15,000 doctors have been invited, and the first 350 to accept will be accommo dated in the main auditorium at New York University Med ical Center. A panel of three doctors will talk about their experiences in performing abortions in their offices. Dr. Nathanson will demonstrate equipment and discuss its use.

IT was against this back ground of medical controversy and uncertainty that, during a two‐week period in May, three agencies issued three sets of guidelines covering implemen tation of the new law.

The first set came on May 12 from the Public Health Council, an arm of the New York State Department of Health. They recommended that abortions after the 12th week of pregnancy be per formed on an in‐patient basis only, and that all abortions, regardless of whether the pa tient remains overnight, be performed in a hospital, a hospital‐run clinic or “a suit ably staffed and equipped facility having a hospital affiliation agreement accept able to the State Hospital Council.”

On May 21, the Health Serv ices Administration of New York City issued its guide lines. They were based on the recommendations of the Health Department's 19‐member Ad visory Committee on Obstet rics and Gynecology, a per manent group composed of medical professors and chiefs of service at large hospitals. Dr. Robert Hall is a member. The chairman is Dr. Saul Gus berg, chief of obstetrics at Mount Sinai Hospital.

The city guidelines followed those of the state in allowing out‐patient abortions up to 12 weeks of pregnancy. They de parted from the state guide lines in restricting abortions to “hospital premises” only— no clinics.

The following week, the Medical Society of the State of New York issued the third set of guidelines. They limited abortion to the 20th week of pregnancy, not the 24th as in the law, since “after the 20th week of gestation, the process cannot be classified as an abortion and constitutes an actual birth process.” In other words, it is possible that fetus delivered after 20 weeks could survive.

Like the others, the society's guidelines limited out‐patient abortions to the period before the 12th week of pregnancy. In red ink and capital letters, the “hot line” newsletter, which presented the guidelines to the society's members, con tained this sentence: “The Medical Society of the State of New York would like to caution all physicians that an abortion performed after the 12th week of gestation is fraught with tremendous dan ger.”

(It is interesting to note that the medical society counts the weeks of pregnancy start ing with the first day of a woman's last menstrual period, although presumably concep tion did not take place until two weeks later. Calculated this way, a woman in her 20th week of pregnancy is carry ing an 18‐week‐old fetus.)

The medical society's guide lines followed those of the state rather than the city in permitting abortions to be per formed in free‐standing clinics with back‐up hospital agree ments, as well as in hospitals and hospital‐run clinics.

SINCE none of the guide lines supplant the state law or have the effect of law at all, there has been confusion about exactly what they mean. The city's guidelines will have the effect of establishing policy for the 18 municipal hospitals which the city administers. But the city exerts no direct control over the majority of hospitals within its borders— 82 voluntary hospitals (i. e., privately owned, nonprofit making), and 36 proprietary (profit‐making) hospitals. To gether, the two private cate gories account for nearly two‐ thirds of the city's total hos pital beds and handle about four‐fifths of the obstetrical cases.

Unless the city incorporates any of the guidelines into its 613‐page health code (a rather lengthy process which requires a public hearing), the guide lines technically have the ef fect, for private hospitals, of recommendations only.

What the sets of guidelines do provide, in a cumulative way, is a definition of “stand ard medical practice” as ap plied to abortion. Standard medical practice is a bland phrase that carries consider able weight in the profession as a guide to doctors in their own practices in a general sense and as a recourse against a malpractice charge under more drastic conditions. Faced with a malpractice suit, one of a doctor's best possible defenses is that he acted in accordance with standard med ical practice.

It is clear that a doctor who performs an abortion in his office after July 1, although it is perfectly legal for him to do so, will be acting against standard medical practice, at least as that definition seems to be emerging. If nothing went wrong with the abortion, probably nothing would “hap pen” to the doctor. If some thing did go wrong, he would be in a difficult position. The county and state medical so cieties have considerable pow er to police their own houses. The county societies can cen sor, suspend or expel members who are found in violation of medical ethics. Such action could prevent a doctor from being able to get malpractice insurance or staff privileges at accredited hospitals.

An analogy could be drawn to the question of performing a tonsillectomy in a doctor's office. Although in the past tonsillectomies were often done in offices, the operation is regarded today as a hospital procedure. A doctor who en countered complications while performing a tonsillectomy in his office would have little defense against a malpractice suit, even though he was not in violation of any law.

So, office abortions are not likely to become popular in medical circles. Because of the disparity between the state and city guidelines, the clinic situation is not so clear. Planned Parenthood and other groups have talked about opening clinics, but no one is expected to move until well after July 1, when the demand and supply picture becomes clearer.

Only the city's guidelines talked about a residency re quirement. Patients at the mu nicipal hospitals are already required to be city residents, and no change will be made for abortion. The private hos pitals are urged to give “pri ority” to city residents.

THE radicals in the abortion movement have not suppressed their outrage at the net of guidelines surrounding the law. “Hospitals will be doling out abortions like a privilege in stead of a right,” Dr. Nathan son said. “Doctors are getting dust thrown in their eyes by technicians and professors acting as experts. These men don't know what's happening with patients. They don't have to listen to some girl's sob story and tell her, Sorry, my dear, there's no bed for you, and send her running off to an illegal abortionist only to have to patch up her infected abortion a week later. There's going to be a terrible public outcry over this that will force the entire medical establish ment to open up.”

“What right has anybody to tell the Legislature of the State of New York, responding to the will of the people, what to do? “asked Lawrence Lader, a well‐known abortion cru sader and chairman of the ex ecutive committee of the Na tional Association for Repeal of Abortion Laws. “It's be yond belief. It's the most crass and absurd thing I've ever heard. What do you pass a law for if a few medical‐hier archy bigwigs are going to make it 50 or 60 per cent in effective? It's absurd that the medical societies that fought the bill in the first place, and were defeated, are still calling the tune.

“There have always been conservatives in any move ment who say to go slow,” Lader continued. “But we've proved that we can take a gamble. We made the abor tion‐repeal movement by forg ing ahead and knocking heads together. It's absurd to take the attitude that because we might make a mistake we have to go slow. We're tre mendous optimists. In a year or two there will be more states with abortion repeal and we won't need the re strictions we put in today. It's shortsighted. At least let's stay philosophically humane. The conservative approach has no place here. You have to do what F.D.R. did in the Depression, attack the prob lem in a sweeping way, not inch inch.”

DESPITE their differences, most doctors do agree on a few aspects of the new law. One is that implementation requires a concerted effort at public education to inform women about the need for early pregnancy tests, the need for early rather than late abortion if that is the decision they make and the existence of some drawbacks to abortion with which most women are not familiar.

Since April, queries have poured into doctors' offices and hospitals from women seeking information. The New York County Medical Society received so many calls, both from the public and from doctors and out‐of‐state medi cal societies, that it sent a questionnaire to its member gynecologists and obstetri cians asking them if they wanted to be listed on a spe cial referral list for abortions. Some of the inquiries have indicated a real lack of knowl edge about abortion, and this has concerned doctors as much the sheer numbers.

“I'm very much concerned that the public not get the Idea that abortion is a substi tute for contraception,” Dr. Kaufman said. “The two are simply not in the same league. We're talking about a surgical procedure vs. a preventive service.”

Even under the best of cir cumstances, abortion carries certain risks for those women who later plan to have chil dren. Dr. Kaufman specializes in the treatment of infertility, and he has observed that the trauma to the cervix and uterus of repeated abortion leads to an increased chance of miscarriage in the second trimester of pregnancy, pre mature birth and about twice the incidence of complioa tions in labor. This is espe cially true if a woman has an abortion before she has ever given birth.

In addition, a slight, often undetectable infection can set up a low‐grade inflammation of the Fallopian tubes, which can result in temporary in fertility or in an ectopic (tubas) pregnancy. The chance of an infection from an abor tion performed under sterile conditions is minimal, but is always present; ordinary child birth also sometimes leads to such an inflammation.

“It's not like a vacuum cleaner—in and out and good by,” Dr. Kaufman said. “We've had the strangulating law for 140 years, and all of a sud den the noose is off and everyone wants implementa tion, like yesterday. So we're caught between trying to get enough medical experience quickly to handle the load and trying to educate the public in how to deal with the new law.”

Most doctors feel that the new law will bring a signifi cant change in their prac tices, and will challenge some well‐ingrained attitudes about abortion. Not only have few gynecologists and obstetricians performed abortions on any kind of regular basis; most of them took no part in the movements for abortion re form or repeal and, in fact, rarely had much contact with the abortion question at all.

So to the average gynecol ogist or obstetrician, whose name has not been in the pa pers and who has gone quietly about his private practice, the law has really opened a closed door. “I didn't do more than whisper about abortion four months agri,” said Dr. Leon Zussman, a Manhattan gyne cologist and obstetrician who has practiced for 30 years, performed about one abortion a year and had to turn down requests for about 40 a year. “Neither did most of my friends. But now it's all we talk about — morning, noon, night and in between. Wheth er we're seeking this or not, it will fall into our laps, so what else is there to talk.

“I will do abortions. Every body I know will do abor tions. But, while I am intel lectually ready, willing and able, I will still have an emotional reaction. I've been so emotionally attuned to this attitude toward abortion throughout my whole career that it will be difficult. It's a challenge. We've all been frustrated all these years by having to refuse so many, so no one will say no now. But I would not want to be known

as an abortionist. Maybe the next generation wouldn't con skier that a stigma, but with me it will persist until I die.”

There will, of course, be doctors who will not perform abortions. Many of them will be Catholic; no abortions will be performed at the Catholic hospitals. All the guidelines state explicitly that no doctor can in any way be penalized for refusing to do an abor tion.

Predictions range from mild to severe forms of chaos

“Even Bob Hall doesn't en joy doing abortions,” Dr. Hall said. “It's not because I think I'm killing a baby. Not that. But it's the potential, the feel ing that if only this pregnancy had occurred at the right time everything could have been different. Delivering a baby, a doctor feels he is part of the process of creation, even if all he does is catch the baby when it comes out. It's a Godlike role, and we like to play it. Doctors do have a God image, and what they cannot buy now is that this law has forced them to as sume social responsibility as well.”

THESE private agonies will soon be swept along by the tide when the gates open on July 1. What can we expect to see? No one expects perfec tion. No one — not even the spokesmen for the Health Services Administration, who are experts at sounding opti mistic — expects that every woman who wants an abor tion on July 1 can get one quickly, at reasonable cost and with a minimum of red tape.

Predictions range from mild to severe forms of chaos. The Health Services Administra tion has announced that the 15 municipal hospitals that have obstetrical services will be able to perform between 25,000 and 30,000 abortions a year. The city is prepared to spend most of a $5‐million contingency fund to help the hospitals develop their facili ties or to hire the staff to use the facilities at normally un derused times — nights and weekends.

(In fact, there is bed space in the obstetrical units of most hospitals. In 1969, the obstetrics services at the mu nicipal hospitals were utilized at an average of 61 per cent of capacity; the gynecology services, 75 per cent. In 1968, use of obstetrical beds aver aged 68 per cent of capacity at the voluntary hospitals, 61 per cent at the proprietary hospitals. Utilization is usual ly lowest in the summer. The bottleneck is staff — nurses, technicians and anesthetists as well as doctors.)

A city patient will not be restricted to the municipal hospital in her neighborhood, as she now is. If there is no room in her neighborhood hos pital, an appointment will be made for the woman before she leaves the first hospital at one where there is space.

Actually, any New York City resident can use a mu nicipal hospital. Patients are charged for procedures on a sliding scale depending on their ability to pay. There is no means test as such, but a patient is asked to state his or her combined family in come and to sign a form say ing that proof of income may be required.

City hospital officials do not, however, expect a flood of wealthy women seeking abortions at the municipal hospitals. Private physicians cannot perform operations there, and most women who have their own gynecologists probably would not want to have their abortions done by a hospital staff doctor they had never met.

The city was still trying 10 days ago to work out a fee schedule for municipal hos pital abortions. Medicaid will cover abortions for indigent patients, both single and married.

MANY of the large volun tary hospitals are waiting un til after July 1 before commit ting themselves to handling any specific number of abor tions. University Hospital was the first to announce a def inite plan, and it may perhaps become a model for some of the others. The hospital will have three programs for its private patients.

First, women pregnant for less than nine weeks will be given out‐patient abortions on Saturday, a day when the operating room is normally used only for emergencies. All preadmission tests must be done ahead of time in the doc tor's office. The woman comes to the hospital on Saturday morning, has the operation, stays in the recovery room for several hours and leaves in the afternoon. Twelve wom en a week will be accom modated under this program.

Women 10 or 11 weeks pregnant will be admitted to

a special six‐bed unit on the hospital's gynecology floor on the afternoon of the first day. They will have the operation the following day and be dis charged on the morning of the third day. Twelve women a week will be accommodated under this program also.

A simple abortion can easily cost $500, a complex one double that

Finally, if a bed is available on the obstetrical floor, one woman a day will be admitted for an abortion by the salt ing‐out method. The patient, from 12 to 20 weeks pregnant, will remain in the hospital three or four days; a max imum of five a week will be admitted. University Hos pital will then be doing 29 abortions a week. That is a start, but clearly if no more than a few hospitals are will ing to make even that limited commitment, there will be trouble.

As more hospitals announce their plans, the private hos pitals may set up some form of clearinghouse to keep track of available beds. One organization, the Family Plan ning Information Agency, Inc., is preparing to handle refer rals in large numbers. In May, the agency sent letters to 55, 000 gynecologists, psychia trists and general practitioners across the country announc ing its referral service. Re plies came back by the hun dreds. Women calling the agency, which is housed in a converted brownstone at 160 West 86th Street, will be able to get current information on available space in both the ward and private sections of the nonmunicipal hospitals.

Out ‐ of ‐ state medical soci eties and Planned Parenthood chapters will probably try to keep up‐to‐date with the New York situation. Women whose own doctors do not have con tacts in New York will sim plify their attempts to get an abortion here if they make as many arrangements as they can before they come. Calling any of these organizations would be a start.

Women who arrive in New York without any arrange ments will unquestionably have the most difficult time. The municipal hospitals will not accept them and, even after getting a list of names from the county medical so ciety, they may have trouble getting appointments with busy doctors here. It is for them — especially the out‐of state poor—that abortion clin ics would make the most dif ference.

But for New York women, the gap between rich and poor, which has always meant the difference between a rela tively safe or frightfully dan gerous illegal abortion, is bound to be narrowed. There may be red tape, waiting lists and impersonality at the mu nicipal hospitals, but abortions will be done there in unprece dented numbers and at low cost for people whose only previous alternative was a wire coat hanger or worse.

Abortions, even where ob tainable in the private hos pitals, will not be bargains. Most gynecologists will prob ably charge between $200 and $300 for an early abortion by D‐and‐C or suction. In addi tion, the anesthetist charges about $75 and the hospital will set its own fees for use of the operating and recovery rooms, probably about $100. Laboratory fees are additional. Thus, without an overnight stay, an uncomplicated abor tion can easily cost $500. A hysterotomy or salting ‐ out procedure could easily double that figure with higher doc tor's fees and several days in the hospital at $100 a day.

Blue Cross had not an nounced by mid‐June whether it would cover abortions or, if it does, whether it would limit coverage to maternity benefit contracts, which would effectively exclude single women.

FOR a few days after April 10, it did look easy. A few years from July 1, when pre sumably other states will have repealed their abortion laws, efficient clinics will be oper ating and emotions will have cooled, it may look easy again. But the day when an abortion carries with it no more bu reaucratic or emotional bag gage than a tonsillectomy will be a long time coming.

“The word abortion still has a seriously soiled, stained meaning,” said Dr. Bernard Nathanson. “People talk about New York becoming the abor tion capital of the world as if that would be a terrible thing. But substitute ‘heart trans plant’ — make New York the heart‐transplant capital of the world and see how their ex pressions change. Well, don't think there should be a difference. I'd be proud if New York were humane enough and had enough com passion to become the abor tion capital of the world, and I think we have to do every thing in our power to make it possible.” ■